Kramp P, Gabrielsen G
Clinic of Forensic Psychiatry, Blegdamsvej 6B, 2, DK-2200 Copenhagen N, Denmark.
Eur Psychiatry. 2009 Sep;24(6):401-11. doi: 10.1016/j.eurpsy.2009.07.007. Epub 2009 Aug 31.
Over the past 40 years, a marked deinstitutionalisation in favour of social and community psychiatry has taken place in many countries. During this same period of time, there has been an increase in the number of mentally ill criminals. The purpose of this study is to analyse the correlations between the reorganization of the psychiatric treatment system, the growing number of forensic patients and the increase in serious crime, homicide, arson and violence associated with the mentally ill.
Using registers and other data sources, we estimated the annual positive or negative growth rate of consumed psychiatric beds and in social and community psychiatry (explanatory variables) and in prevalence and incidence of forensic patients, homicide, arson and violence (response variables) from 1980 to 1997 for each of the Danish counties. We analysed the immediate effect of the changing treatment structure by relating response variables to explanatory variables. The long-term effect was analysed in the form of between county analysis with both single and multiple regressions.
Bed closure had no immediate effect on either the number of forensic patients or serious criminality. The between county analysis shows, however, that over time the (negative) growth rate in number of consumed beds is significantly correlated with the (positive) growth rates for forensic patients, homicide and arson. Social and community psychiatry have little effect, if any.
The study is based on historical data, but the results are still valid. We have used two sets of data firstly the number of forensic patients and, secondly the reported number of crimes associated with the mentally ill. The uniformity of the results leads us to consider them for certain: That the decreasing effort invested in inpatient treatment is causing an increase in the crime rate among the mentally ill.
Many forensic patients suffer from schizophrenia. These patients are not only offenders, but also the victims of an inadequate treatment system. Modern inpatient treatment facilities should be established.
在过去40年里，许多国家都出现了明显的去机构化趋势，转而支持社会和社区精神病学。在同一时期，患有精神疾病的罪犯数量有所增加。本研究的目的是分析精神病治疗系统的重组、法医鉴定患者数量的增加以及与精神疾病相关的严重犯罪、凶杀、纵火和暴力事件增加之间的相关性。
我们利用登记册和其他数据来源，估算了1980年至1997年丹麦各郡消耗的精神病床位以及社会和社区精神病学（解释变量）的年正增长或负增长率，以及法医鉴定患者、凶杀、纵火和暴力事件的患病率和发病率（反应变量）。我们通过将反应变量与解释变量相关联来分析治疗结构变化的直接影响。长期影响则通过单变量和多变量回归的郡间分析形式进行分析。
床位关闭对法医鉴定患者数量或严重犯罪率均无直接影响。然而，郡间分析表明，随着时间的推移，消耗床位数量的（负）增长率与法医鉴定患者、凶杀和纵火事件的（正）增长率显著相关。社会和社区精神病学即便有影响，也微乎其微。
本研究基于历史数据，但结果仍然有效。我们使用了两组数据，一是法医鉴定患者的数量，二是与精神疾病相关的犯罪报告数量。结果的一致性使我们有理由确定：住院治疗投入的减少导致了精神疾病患者犯罪率的上升。
许多法医鉴定患者患有精神分裂症。这些患者不仅是罪犯，也是治疗系统不完善的受害者。应建立现代化的住院治疗设施。
